Provider Demographics
NPI:1447429683
Name:HAYNES, LINDSEY WATSON (PA)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:WATSON
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:BLAIR
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:24 ALICIA LANE
Practice Address - Street 2:STE 7
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1637
Practice Address - Country:US
Practice Address - Phone:706-391-6555
Practice Address - Fax:706-391-6557
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1080900363AM0700X
GA005286363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003146453AMedicaid
GA003146453BMedicaid